Horace: HIV Background

HIV infection leads to which disease if untreated?

AIDS

AIDs is defined as:

CD4 T cell count of < 200

or

< 14% of total T cell count

or

diagnosis of one of the AIDs defingin conditions

first known case of HIV was in ____

1959

what are the three modes of transmission for HIV

sexual

parenteral

perinatal (vertical)

what is the main method of HIV transmission

sexual intercourse

what type of sex causes the most HIV transmission

receptive anal sex

what are the ways that HIV can be transmitted parenterally?

blood transfusions

injection drug use (sharing needles)

skin puncture

mucous membrane contact

how can vertical transmission of HIV occur

through pregnancy, delivery, and breast feeding

the longer the time from membrane rupture to delivery will ____ the risk of vertical transmission of HIV

increse

HIV + moms are instructed to not ____

breast feed

what is the hallmark of untreated HIV infections

profound T cell depletion and severe immunosuppression that puts the pt at a hgih risk for opportunistic infections

what is the main cause of morbidity and mortality in pts with HIV

opportunistic infections in setting without access to antiretroviral drugs

which cells does HIV infect

T-helper lymphocytes, monocytes, macrophages, dendritic cells, and brain microglia

what receptor does HIV particles bind to

CD4

CD4 receptors are found on which cells

T-helper lymphocytes, monocytes, macrophages, dendritic cells, and brain microglia

explain what the green circle is representing

this is the highest a pts CD4 cell count will be in their whole life is they never get any tx

what does the red arrow point to

CD4 level of 200 which is when a person is diagnosed with AIDS

if it takes a person 10 years after an HIV infection to be symptomatic then they are called…

long term non-progressors

long term non-progressor

someone that took 10 years to show any symptoms of HIV infection

how long is the acute phase of HIV (1)

6 to 24 weeks

how long is the asymptomatic and symptomatic phase of HIV (2)

½ a year to 10 years

how long is the AIDs phase (3)

2-3 years

who should be tested for HIV

anyone with STIs

high risk pts

all preg ppl

ppl with tuberculosis

pplk with HBV or HepC

anyone between 13-64 yrs of age

who is considered high risk for HIV

ppl with alot of sexual partners, sex workers, and ppl who share partners

anyone aged ____ should be tested for HIV

13-64

anyone with which diseases should always be tested for HIV

tuberculosis, HepB and HepC

what are the two categories of testing that can be done for HIV

antibody testing and confirmatory testing

what are the antibody testing options for HIV

Enzyme-linked immunosorbent assay (ELISA)

Rapid tests like OraQuick

what is the minimum time for antibody production to occur in a pt with HIV

3-4 weeks

what are the confirmatory tests for HIV

western blot

detection of antigens to HIV

HIV-1 RNA testing is used routinely to…

follow progression and response to therapy

what is the goal number of copies of HIV RNA in a person

< 50 copies (suppressed and undetectable)

suppressed/undetectable amount of HIV RNA copies

< 50 copies/mL

low to moderate amount of HIV RNA copies

50-100k copies/mL

high amount of HIV RNA copies

> 100k copies / mL

both CD4 Counts and HIV-1 RNA testing are RARELY used for…

diagnosis

CD4 count testing is used routinely for…

following the progression and response to therapy

normal immune system CD4 count

500 +

weakened immune system CD4 count

200-499

AIDS CD4 count

< 200

anti-retroviral therapy (ART) is rec for ___________ to reduce the risk of disease progression and to prevent transmission

all HIV-infected individuals (regardless of timing)

which two studies changed the guidelines on when to treat a person with HIV

START and TEMPRANO

START and TEMPRANO lead to

changing the guidelines to say that a person should immediately be treated for HIV

at the beginning of an HIV infection it is more likely that the person has which type of virus

wild type

wild type virus

unmutated original copy

what are the goals of HIV tx

To achieve maximal and durable suppression of HIV replication, interpreted to be a sustained plasma viral load less than the lower limit of quantitation

a HIV tx goal is to increase CD4 cells to ____

> 200

a HIV tx goal is to reduce the HIV viral load to ____

< 50 (undetectable)

HIV tx goal is to prevent ____ and decrease the risk of _____

transmission; opportunistic infections

HIV tx goal is to decrease ___ and ____

morbidity and mortality

HIV can be very inflammatory which leads to

increased risk of cardiovascular issues and MI

all pts with HIV should be started on a _____ due to inflammatory nature

statin drug

HIV can lead to which type of pain

neuropathic

HIV can lead to damage to which organ

kidney

Persons starting ART should use another form of prevention with sexual partners for _________ of treatment and until an HIV RNA level of <200 copies/mL has been documented

at least the first 6 months